Cyclical breast pain (physiologic) – most common.
Fibrocystic disease
Mastitis; breast abscess
Chest wall pain
Idiopathic breast pain
Caffeine, nicotine
Large breast size (stretches Cooper’s ligament)
Breast structure: Breast cysts/macrocysts; Breast trauma; prior breast surgery, etc.
Extramammary breast pain: Chest wall, muscles, joints or heart, Gallbladder, etc.
Pregnancy
Cancer (rarely causes pain); Inflammatory breast cancer; Ductal ectasia
Heart disease; Myocardial infarction
Pulmonary embolus
Shingles (Herpes zoster)
Medication use: Antidepressants, antipsychotics, estrogen, progesterone, clomiphene, antibiotics, antihypertensives, metronidazole, ketoconazole, spironolactone
Hormone replacement therapy
Breast fibroadenoma
Benign tumors
Psychiatric
Thrombophlebitis
Gastroesophageal reflux disease
Pleurisy, pericarditis
Sickle cell disease
Hidradenitis supprativa
Spinal and paraspinal disorders
Referred pain e.g. Gallbladder disease (referred to the chest)
Post-thoracotomy syndrome
Breast augmentation disorder (implants)
Gynecomastia (men)
Thinking through the differential
May divide the ddx into Mammary causes (from within the breast) and extramammary causes (causes outside the breast). I.e. intrinsic and extrinsic breast pain.
Intrinsic breast pain may be divided into cyclical and noncyclical breast pain.
“Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. ” Mayo Clin Proc. 2004.
Further Reading
Mayo Clin Proc. 2004 Mar;79(3):353-72.Evaluation and management of breast pain. https://www.ncbi.nlm.nih.gov/pubmed/15008609
https://www.ncbi.nlm.nih.gov/books/NBK277/